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Read the report all you want, but for 12 months I’m not reimbursed. And no explanation why. No wonder they can’t get doctors.

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Yet another call just now from TriWest asking me to treat a veteran. VA crisis lines leave vets in limbo. Calls go to voice mail. Veterans have killed themselves just after calls to crisis lines. A lot of these suicides are due to PTSD. Veterans cannot get the help they need.

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I believe it is TriWest who won the contract to schedule suicidal veterans who have Treatment Resistant Depression or PTSD or Bipolar Depression. I treat that. It works except in the most extreme cases, in minutes to just a couple days. It’s simple and safe for outpatient use. It has been tested at NIMH and Yale since 1991. The VA-UCSD psychiatrist referred him and then continued care.

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I will not see one more veteran until I am reimbursed for the 5 pre-approved visits for a veteran I treated 12 months ago. He was better in a few days, the first time in decades he had relief of depression. If you cannot pay me who can relieve treatment resistant Major Depression in 2 days, then honey, no wonder you can’t find docs to help. They limited me to their chosen codes for billing. I spoke to psychiatrists who work with veterans and they have never heard of those codes. I guess they just mean loud and clear: NO PAY. Fine. It was a pay cut to offer and took weeks of paper forms, months of approval – you have to really want to do it. With frequent help from a very experienced clerk and a doggedly informed veteran who knew all the ropes, it took months for paperwork to get rushed through. Plenty of doctors just graduating this month don’t know how many months paperwork takes and they won’t get paid.

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San Diego VA has the worst reputation in the nation. I understand it is the San Diego VA that has the worst lag time delays of several months before veterans can even be seen. Worst in the country. Correct me if I’m wrong. And we have a lot more veterans because warm sunny weather is easier on their bones. Is that any excuse to dis-incentivise any doctor by not paying for services?

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The new veterans suicide hotline does not even return all calls. Public Radio just had an expose’ on this one or two weeks ago.

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Twenty veterans take their life daily.

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Only 30% of people with depression respond to antidepressants.

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Based on publications from major academic centers, treatment resistant depression, it seems, is diagnosed after failing as few as 3 or 4 antidepressants.

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Compare any antidepressant to ketamine with potential relief in hours to a couple days.

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It’s not like this is new. In 1991 ketamine was first studied at NIH for depression. Yale has carried the work forward with them. But people live at home and it has to be cost effective. It is unnecessary and/or unaffordable for most people including taxparers to be paying for IV infusions when many or most patients do well on sublingual or nasal use. It is the #1 drug of abuse in China, so don’t just offer it to any person who needs it. Make sure you understand how important glial modulators are in depression. See Yale with NIMH publication on inflammation in depression, I posted on these pages about 3 or 4 years ago when it came out.

In January 2012, I posted detailed information:

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PTSD has a more direct link to suicide than previously thought, a current Texas A&M University study concludes – references below.

A high lifetime risk of suicide occurs in women who have been sexually and physically abused as young girls.

More than 300,000 veterans have been diagnosed with PTSD or major depression – many not yet diagnosed.

Risk of suicide is the highest during the first month of standard antidepressant therapy, and a significant number of patients do not have adequate improvement even after months, resulting in harm to personal and professional lives.

Patients are at suicide risk upon discharge from psychiatric hospitals.

Significant predictors of both suicide attempts and preoccupation with suicide are guilt and anger and impulsive behaviors.

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Ketamine is the most important breakthrough in treatment of major depression with rapid and lasting effects.

Ketmine can help immediately, unlike all other antidepressants that may require weeks or months to work, if they help at all. See NPR report here – that appeared soon after I posted this (skip to their last section). It is FDA approved and legal. NPR again reportsketamine’s rapid relief of depression.

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The medical literature on ketamine use is profoundly important. There are over 6,800 medical publications.Ketamine has potent healing powers. Karl Jansen, psychiatrist in London, believes that “ketamine has potent healing powers when used as an adjunct to psychotherapy.” There is nothing like it; however, treatment for serious depression still requires team support, not medication only.

The World Health Organization reports that disability to due depression is second only to heart disease.

Suicide is a catastrophic medical emergency. I cannot stress this enough. Depression is treatable.

Your death is unnecessary. It would be a terrible loss to all who love you.

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Please read that entire post January 2012 before you call to ask questions. The calls are very time consuming.

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There is no reason to restrict life and death matters to one drug, and then make it dependent upon only IV infusions. What kind of life is vegetating in depression for decades? It is a short acting drug. I have posted on why ketamine should never be used alone, but must be used with other glial modulators.

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Most troubling:

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Compounded Medications are Not Covered by Any Insurance

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Most people cannot afford compounded medications, especially if disabled due to Major Depression or PTSD or pain – same medications work on mood and pain.

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TAKE ACTION

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Healthy people can get back their lives. These simple steps can be taught across the nation. Millions are needlessly disabled, especially our young adults who are most vulnerable to these disorders, and several hundred thousand of our young veterans.

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An entire nation can get and breathe relief.

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DO THIS:

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Call your favorite politician and relevant organizations who care about healthcare and veterans to STOP the collusion and restraint of trade since all insurers began refusing to cover compounded medications. All these new $100,000 per year medications are paid for by the taxpayers and your insurance deductible that goes up every year. How long will you be able to afford medical care? How long can this restraint of trade be practiced under our noses unless we take action?

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Get this on the Democratic platform this presidential year. It’s a scam perpetuated by multibillion dollar pharma and their mighty rich contributions to congress who are killing affordable medical care.

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Affordable medical care

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These medications must be compounded. How many can afford $200 to $300 or more cash out of pocket just for medications? Or will this become another safe old drug that is bought by a financier, patented, and now they charge $100,000 a year? You know who pays for everything and it ain’t the 1%.

.Announcement updated May 31

I am working now with

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LaVita has become an outstanding, award winning local compounding pharmacy – see their awards and information below. I think you will like them.

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Sadly announcing PJ’s Pharmacy sold to Walgreens on May 26 — I learned only hours before the close. PJ’s did not know until the moment papers were signed because contracts can always disappear. Five local compounding pharmacies lost their business in recent months. We will miss 20 years or more of always always being able to rely on PJ’s for great work and their wonderful friendly service! Small compounding pharmacies are invaluable to our communities and veterans. Their struggle and loss is a sad commentary on the practice of medicine today.

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Now when you call PJ’s number the call transfers to Walgreens Compounding, who now holds all of PJ’s recipes, your prescriptions and refills.

On Walgreens first day, 5/31, a PJ’s patient texted me:

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“Walgreens had actually messed up the rx-dates, mgs and the number to be refilled all 3 are wrong in the rx they called over. So please caution your patients to check what they are expecting to get.

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In my case 10mg became 100, 20 pills became 60. I could become dead but the pharmacist (receiving) called me to say politely, ‘We are wondering if this is what you were expecting and we are wondering how we would fill it.’ “

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To transfer from Walgreens to LaVita, intructions are in red below.

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For your initial visit, Rx that I sent to PJ’s is now with Walgreens. Please make sure you call LaVita ASAP long before your first visit to transfer Rx.

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Please hold any further questions until the time of visit. I hope you can appreciate how many days this has unexpectedly taken already.

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Subscribe to RSS at top right of this site for future posts automagically. This field is evolving very quickly.

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Please read entire page

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To transfer from Walgreens to LaVita

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Starting Tuesday May 31, PJ’s calls are automatically transferred to Walgreens. I will work only with LaVita.

Speak to LaVita Compounding to set up an account with them and ask La Vita staff to call Walgreens at (619) 221-0834 to transfer your prescription from Walgreens to LaVita

This applies to all those with an upcoming initial office visit and for those with prior refills —-ask LaVita to transfer your prescriptions from Walgreens. A pharmacy to pharmacy transfer can occur only with your request to LaVita.

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It is you who must call LaVita and give them information.

Rx transfers directly pharmacy to pharmacy.

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I have no information on Walgreens compounding but early results are very seriously wrong.

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The Small Business Administration (SBA) awarded La Vita Compounding Pharmacy the prestigious Director’s Award for Business Creativity and Growth within San Diego and Imperial Counties. La Vita was also honored by the National Association of Women Business Owners (NAWBO) as San Diego’s 2015 Woman Owned Business of the Year.

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They are closer to the office, and they ship to 11 or 12 states. I look forward to working with them.

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Compounding pharmacies are generally open Monday through Friday.

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Thanks to PJ’s for 20 years of excellence.

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It was a privilege to work with everyone at PJ’s Pharmacy and Compounding, to learn from their expertise, first from Mary and, in recent years, from Marjolein whose PharmD was so helpful and whose information added so much.

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Best wishes to all!

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I wish you all a wonderful summer – please get some time out!

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For those with CRPS RSD, note a new comment on this site,

this month on Neridronic Acid. Just use search function top left above photo.